• Baby Care
• Your Family's Health

How To Care For Your Child’s Barky Cough

If your child has a cough that sounds like a barking seal, he or she may have croup. 

A common illness in young children, croup causes swelling of the voice box and windpipe. The swelling makes breathing noisy and difficult, and it can be scary for parents and children. 

The good news is that most of the time, you can manage your child’s croup at home.

Who’s At Risk? 

Viruses like influenza and RSV, and sometimes bacteria, cause croup. The infection is most common in the winter, between October and March, but it can occur at any time of year. 

Children from 3 months to 5 years old are most likely to get croup. Older children also can be infected, but croup becomes less common as the windpipe grows larger. This makes swelling less likely to cause breathing problems. 

Croup may also be caused by: 

• Allergies
• Breathing in something that irritates the airway
• Acid reflux

Symptoms And Types Of Croup 

The symptoms of croup are similar to those of a cold. Children typically have cold-like symptoms for a few days before the cough appears. Croup symptoms can last about a week and are often worse at night. 

Common symptoms include: 

• A fever
• Runny nose
• Hoarseness
• Wheezing
• A barking cough

Stridor is a harsh, loud, high-pitched noise your child makes when he or she takes a breath. This is common with croup when your child is active or crying.

There are different types of croup:

• Viral croup. The most common form of croup is a viral infection of the voice box and windpipe. It often starts out just like a cold, but then turns into a barky cough. Your child's voice will become hoarse and breathing will get noisier. Stridor may develop and your child may have a fever.
• Spasmodic croup. An allergy or acid reflux causes spasmodic croup, which comes on suddenly, usually in the middle of the night. Your child may wake up gasping for air and have a hoarse voice and stridor when breathing in. A barky cough also may be present. Spasmodic croup is similar to asthma and usually does not cause a fever.
• Croup with stridor. If your child has stridor while resting, this can be a sign of more severe croup. As breathing becomes difficult, your child may stop eating and drinking. Your child may also become too tired to cough. This type of croup can be dangerous if the airway swells too much – and may require emergency care at the hospital.
• Recurrent croup. If your child gets croup repeatedly, she may have a narrowing of the airway unrelated to an infection. Talk with your doctor about having an ear, nose, and throat specialist (otolaryngologist) or a breathing and lung specialist (pulmonologist) evaluate your child.

Symptoms of severe croup include: 

• Stridor while resting
• Fast or difficult breathing
• Flaring nostrils
• Unusual restlessness
• Retractions (your child's chest and stomach muscles suck in)
• A blue tint to the lips and fingernails

If your child shows signs of severe croup, seek immediate medical care. 

Children from 3 months to 5 years old are most likely to get croup.

Making a Diagnosis 

To make a croup diagnosis, your doctor will examine your child and talk with you about his symptoms. 

Your doctor will perform a physical exam to check for: 

• Chest retractions with breathing
• Difficulty breathing in and out
• Wheezing
• Decreased breath sounds
• Narrowing of the airway

Sometimes an X-ray is taken to check the airway. 

Treatments To Improve Breathing 

Treatments for croup focus on making your child comfortable and reducing airway swelling to improve breathing. In most cases, you can manage croup at home. Find ways to relax and calm your child, such as reading a book or playing music she likes.  

Call your doctor for advice or if you have questions. 

Treatment options include: 

• Medicine. Medicines such as acetaminophen or ibuprofen can ease pain and reduce a fever. Avoid cough medicines.
• Steroid medicines. Steroids can reduce swelling and improve symptoms. These medicines can be inhaled as a breathing treatment or taken by mouth or by injection.
• Breathe cool mist. Run a humidifier in your child’s bedroom, have her sit in a steamy bathroom, or expose her to cool outside air to make breathing easier.
• Antibiotic medicine. If your child’s croup is bacterial, antibiotics can help fight the infection.
• Hospital care. If your child struggles to breathe or becomes dehydrated, emergency or inpatient care may be needed. Medicines and treatments may include;
• An oxygen tent placed over a crib
• Breathing medicines given with a nebulizer machine
• Steroid medicines given through a vein (intravenously or by IV)
• Fluids to treat dehydration, given through a vein
• Antibiotics given through a vein

Take Steps To Prevent Croup 

You can take precautions to avoid croup infections – similar to how you prevent the spread of most types of germs. 

To help prevent croup, you should: 

• Ensure everyone in your home washes their hands often.
• Throw away dirty tissues from runny noses and sneezes right away.
• Frequently wash toys in hot soapy water if the toy was in a child’s mouth – especially if the child has a respiratory infection.
• Ask anyone with a cough to avoid kissing or playing with your child.

Sources: American Academy of Family Physicians; Healthy Children; Medline